AB1095 POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS AFTER COVID-19 VACCINATION: A CASE REPORT
Authors: D. Abdel Mohsen, R. A. Elziaty, A. A. Abdalkader
Journal: Annals of the Rheumatic Diseases (2022)

Background The COVID-19 pandemic has infected millions of people around the world and there has been a new surge of virulent strains in many parts of the world[2]. Patients with Systemic Lupus Erythematosus (SLE) were reported to be at higher risk of SARS-CoV-2 infection and worse outcomes from COVID-19, possibly due to their intrinsic immune dysfunction, demographics, disease activity, medications, associated organ damage, comorbidities and as such, have been among the first to receive the vaccines [3]. The most common reason for vaccine refusal in patients with SLE is fear of SLE disease flare. Additionally, SARS-CoV-2 mRNA vaccines could potentially induce interferon production, associated with increased SLE disease activity[1]. Objectives we report a case of SLE presented with lupus flare after receiving the 1st dose of phizer vaccine. Methods A 30-year-old female patient, kown case of SLE since 2011 well controlled on low dose steroids, hydroxychloroquine and azathioprine. Upon receiving her 1st shot of Pfizer-BioNTech COVID-19 Vaccine, she developed high grade fever associated with generalized tender papulovesicular skin eruption mainly on the back of the trunk and the outer surface of both thighs, then she developed generalized tonic-clonic convulsions and transferred for Intensive Care Unit (ICU), intubated, mechanically ventilated and received intravenous anti-epileptic medications. During her admission, Cerebrospinal fluid (CSF) examination and Magnetic Resonance Imaging (MRI) brain were done.she regained her consciousness, extubated after 48 hours. Results The initial laboratory invwstigations revealed COVID19-PCR: negative,ESR: 35 mm/hr,CRP: 78,C3: 70 mg/dL (90 – 180) and C4: 8 mg/dL (10 – 40).CSF examination revealed proteins: 116.9 mg/dL (15 – 45),glucose: 46.3 mg/dL (50-60% of serum),LDH: 49.1 U/L (10% of serum) and no cells.Emergency MRI brain was performed revealed multiple bilateral symmetrical mainly cortical and subcortical abnormal signal with cortical swelling are seen mainly involving both occipito-temporo-parietal lobes with patchy enhancement of left cerebellar hemisphere, cerebellar vermis, both thalami, medulla and pons,Picture suggestive of Posterior Reversible Encephalopathy Syndrome (PRES).Accordingly the patient received received pulse steroid therapy for 3 days under cover of oral acyclovir.She also received levetiracetam and Oxcarbazepine.the condition markedly improved and discharged from the hospital for follow up after one month. Conclusion 1)The mRNA COVID Vaccine may rarely cause CNS affection, or even SLE flare so, SLE patients must be well controlled before giving the Vaccine. 2) SLE patients must be monitored closely by clinical examination and laboratory investigations after taking mRNA COVID Vaccine. References [1]Barbhaiya M, Levine JM,Siege C,Bykerk VP,Jannat-Khah D and Mandl LA.1201 Flares after SARS-Cov-2 vaccination in patients with systemic lupus erythematosus. Lupus Science &amp; Medicine 2021;8 [2]Fernandez-Ruiz R,Paredes JL and Niewold TB. COVID-19 in patients with systemic lupus erythematosus: lessons learned from the infammatory disease.Transl Res.2021;232:13-36. [3]Tang W, Askanase AD, Khalili L, Merrill JT. SARS-CoV-2 vaccines in patients with SLE. Lupus Sci Med. 2021;8(1). Disclosure of Interests None declared